The Oral Health Care Needs of Young Adults Transitioning from Foster Care

Background and Purpose: The purpose of this mixed methods study is to identify factors that have positively or negatively affected foster care alumni in accessing dental care. Medicaid regulations require that states provide dental care to children through the Early and Periodic Screening, Diagnostic, and Treatment benefit through age 20.

When young adults exit foster care they often are left without any health or dental care almost immediately. Young adults exiting foster care rely on the practices of the government in the role of a legal parent to ensure their health. While the Patient Protection and Affordable Care Act of 2010 offers a new category of Medicaid health insurance for foster alumni up to age 26, dental care is not a mandatory service.  States retain the prerogative to offer or not dental health services to their adult Medicaid insured.

Methods: Survey data was collected from 73 transitioning foster care youth and foster care alumni focusing on their current oral health and access to dental care. Additionally, 50 participants took part in a focus group or individual interview. About half the group had unmet dental needs (51.6%) and 20 (32.3%) had not visited a dentist in the past year.

Race, gender, and number of placements were examined for within group differences.  Gender was found to be associated with having unmet dental needs. Two logistic regressions were performed to determine which independent variables of foster care experience (those who left foster care independently, those who left care into a supported arrangement) and age (20 years and under, over 20) are predictors of having dental needs met and having dental insurance. 

Results: Permanency arrangement when exiting foster care has a unique impact on oral health when controlling for race, gender, and age. Young adults who left foster care without support were 4.3 times more likely to have unmet dental needs.  Those who were aged 20 years and younger were 3.6 times more likely to have dental insurance.

Common themes that arose in the focus groups and individual interviews were the need for treatment of “rotting” teeth and removal of wisdom teeth. Seventeen of the 50 interviewed (34%)  reported having serious dental problems that included severe pain and infection without a means of treatment.

Conclusions and Implications: Implications for policy and practice address enhancements to the special foster care Medicaid category under the PPACA of 2010, strengthening promising practices that keep foster care alumni eligible for Medicaid, requiring basic and uniform dental care services, and provision of incentives to dentists to serve Medicaid insured.

Further research is needed to understand the specific factors related to being in foster care, dental disease, access to dental care and what happens once the young adult is on their own.  Having appropriate dental care is crucial to overall health, social relationships, and employability. As one foster care alumni put it, “Nobody wants to walk around looking like a pumpkin, you know?”